CMS: Help Wanted in the Form of Unified Program Integrity Contractors

Original story posted on: July 29, 2015

The alphabet soup of regulatory acronyms is becoming denser. The Unified Program Integrity Contractors (UPICs) are coming, as the Centers for Medicare & Medicaid Services (CMS) is soliciting bids for a program that will consolidate a number of functions currently carried out by other contractors conducting Medicare and Medicaid audits. 

CMS is issuing a request for proposal (RFP) to solicit services for the UPICs.

According to CMS, the UPICs will combine and integrate existing CMS program integrity functions carried out by multiple contractors in order to improve its capacity to swiftly anticipate and adapt to the actions of those involved in healthcare fraud, waste, and abuse across the Medicare and Medicaid program integrity continuum. 

As reported here last July by Ralph Wuebker, MD, MBA, chief medical officer for Executive Health Resources, the primary areas to be pursued by UPICs are anticipated to include the following:

  • Patient abuse or harm;
  • Ability to prevent future fraud, waste, or abuse by taking administrative actions to remove providers or suppliers from the affected program, or otherwise prevent inappropriate future payments;
  • Multi-state fraud;
  • Particularly costly potential overpayments;
  • Likelihood for an increase in the amount of fraud or the emergence of a pattern, including the potential that findings can be used to refine CMS's anti-fraud prevention efforts and analytic models;
  • Fraud complaints made by Medicare supplemental insurers;
  • Law enforcement requests for assistance that involve court-imposed deadlines;
  • Law enforcement requests for assistance in ongoing investigations that involve interagency initiatives or projects;
  • Law enforcement requests for early administrative actions to prevent or mitigate losses to the affected program(s); and
  • Other new elements that may be identified by CMS through technical direction.

UPICs will be tasked with reducing fraud, abuse, and waste within CMS, and they will operate under multiple legislative authorities.

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Chuck Buck is the publisher of RACmonitor and program host of Monitor Mondays.

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Chuck Buck

Chuck Buck is the publisher of RACmonitor and is the program host and executive producer of Monitor Monday.

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